2021 DAHCC Membership Application for Credit Card Users

Please complete the information below. If you wish to pay by check, use the mail in form for submitting your application and payment by mail.

Membership Type & Payment Plans

Multi-Licensed Additional Fee

Same Ownership licenses combined = Revenue Tier + additional fee for each additional license (excluding your primary membership license)

$350 per license | Enter the total amount for all licenses (except your primary)
$500 per license | Enter the total amount for all licenses (except your primary)

Please provide the following information and use the upload option below:

Click or drag a file to this area to upload.

Agency Primary Representative

Provide the information as you wish it to be listed:

Agency Alternate Representative

Provide the information for your alternate as you wish it to be listed:

Share the Knowledge:

Members may add as many staff as you wish per paid member license.
Multi-licensed Members: If you have remote support office staff employed by your company at a non-licensed location and wish for them to be included in DAHCC communications, you may include them as staff of your primary license membership.
Click or drag a file to this area to upload.
(as acknowledgement all information is accurate)

PAYMENT INFORMATION

$ 0.00

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